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投稿时间：2024-01-17 网络发布日期：2024-03-20
投稿时间：2024-01-17 网络发布日期：2024-03-20
中文摘要: 目的 分析影响三阴性乳腺癌（TNBC）新辅助化疗（NAC）后病理完全缓解（pCR）的临床与病理因素。 方法 收集2018年1月至2023年9月于新疆医科大学第一附属医院行NAC及手术治疗的78例TNBC患者的临床与病理资料行回顾性分析，按其是否达到pCR分为pCR组(n=28)和non-pCR组（n=50），采用logistic回归分析影响pCR的临床与病理因素，并比较TP方案（紫杉类+铂类）与TAC方案（紫杉类+蒽环类+环磷酰胺）NAC后pCR率和不良反应发生率。 结果 总体pCR率为35.9%，两组患者在瘤体直径、化疗周期、化疗方案、紫杉醇类型、人类表皮生长因子受体2 (HER-2)表达、Ki-67表达及雄激素受体（AR）阳性表达方面差异均具有统计学意义（P＜0.05）。多因素分析显示，瘤体直径≤3 cm是pCR的独立有利因素（OR=4.191, 95%CI: 1.246~14.094, P=0.021），AR阳性表达是pCR的独立不利因素(OR=0.124, 95%CI: 0.020~0.784, P=0.027)。另外，TP方案的pCR率显著优于TAC方案［54.8%(17/31) vs 28.1%(9/32), χ2=4.636, P=0.031］，且两者的不良反应发生率差异无统计学意义(P＞0.05)。结论 TNBC新辅助化疗采用TP或TAC方案并选用白蛋白结合型紫杉醇均有利于达到pCR状态，但TP方案的pCR率优于TAC方案，且不良反应发生率相当。而瘤体直径≤3 cm的pCR率更高，HER-2低表达，或Ki-67低表达，或AR阳性表达均预示较低的pCR率，且AR阳性表达是pCR的独立不利影响因素。
Abstract:Objective To analyze the clinical and pathological factors affecting pathological complete response (pCR) of triple-negative breast cancer (TNBC) after neoadjuvant chemotherapy (NAC). Methods A retrospective analysis was conducted in 78 TNBC patients treated with NAC and surgery in The First Affiliated Hospital of Xinjiang Medical University from January 2018 to September 2023. The patients were divided into pCR group (n=28) and non-pCR group (n=50) based on whether they had achieved pCR or not. Logistic regression analysis was used to investigate the clinical and pathological factors affecting pCR. The pCR rate and incidence of adverse reactions after NAC between TP regimen (taxane+platinum) and TAC regimen (taxane+anthracycline+cyclophosphamide) were compared. Results The overall pCR rate was 35.9%. There were statistically significant differences between the two groups of patients in tumor diameter, chemotherapy cycle, chemotherapy regimen, paclitaxel type, human epidermal growth factor receptor 2 (HER-2) expression, Ki-67 expression, and androgen receptor (AR) positive expression (P＞0.05). Multivariate logistic regression analysis showed that tumor diameter ≤ 3 cm was an independent favorable factor of pCR(OR=4.191, 95%CI: 1.246-14.094, P=0.021), and AR positive expression was an independent unfavorable factor of pCR (OR=0.124, 95%CI: 0.020-0.784, P=0.027). In addition, the pCR rate of the TP regimen was significantly better than that of the TAC regimen ［54.8%(17/31) vs 28.1%(9/32), χ2=4.636, P=0.031］, and there was no significant difference in the incidence of adverse reactions between two groups (P＞0.05). Conclusion TP or TAC regimen and albumin bound paclitaxel in NAC for TNBC is beneficial for achieving pCR status, but the pCR rate of TP regimen is better than that of TAC regimen, and the incidence of adverse reactions is comparable. The pCR rate is higher for tumor diameter≤3 cm, while low expression of HER-2, Ki-67, or AR indicates a lower pCR rate. AR positive expression is an independent unfavorable factor of pCR.
keywords: Triple-negative breast cancer Neoadjuvant chemotherapy Pathological complete response Clinical pathological features Paclitaxel Androgen receptors Human epidermal growth factor receptor 2
文章编号： 中图分类号：R737.9 文献标志码：A
基金项目:国家自然科学基金地区项目（32260186）
引用文本：
段帅,地力木拉提·艾斯木吐拉,王海燕,郭晨明.三阴性乳腺癌新辅助化疗病理完全缓解的影响因素[J].中国临床研究,2024,37(3):354-358.
段帅,地力木拉提·艾斯木吐拉,王海燕,郭晨明.三阴性乳腺癌新辅助化疗病理完全缓解的影响因素[J].中国临床研究,2024,37(3):354-358.